Individual
DESIREE ALECE FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5725 NE PRESCOTT ST, PORTLAND, OR 97218-2275
(503) 402-8101
Mailing address
5725 NE PRESCOTT ST, PORTLAND, OR 97218-2275
(503) 402-8101
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
226398
—
OR
Enumeration date
08/13/2021
Last updated
08/13/2021
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